Viewpoints: Medicare At Age 50? It’s Something To Think About; Surviving Or Enduring GOP Tax Plan

Bloomberg: Medicare Should Start At 50
Yet again, the U.S. has come in last in a survey measuring the state of health in developed countries. This latest piece of disheartening news put the spotlight on people over 65 -- the age when Americans become eligible for Medicare. The survey, produced by the Commonwealth Fund, included more than 23,000 people from 11 developed countries, and revealed that American seniors were sicker than their counterparts in other countries and are more likely to go without needed health care because of costs. (Faye Flam, 12/6)

The New York Times: Living With The Republican Tax Plan
The [tax] bill’s repeal of the individual mandate will create additional challenges for the struggling Obamacare exchanges. But the mandate has never worked as its creators intended, it remains more unpopular than Obamacare as a whole, and it penalizes a narrow class of middle-class individual market buyers instead of spreading the burden of the system’s costs more widely. In the long run any universal health insurance system will be on a firmer political footing if it finds a way to work without requiring people to buy a product they don’t want. (Ross Douthat, 12/6)

The New York Times: The Republic Will Survive The Tax Bill
The tax bill is not a backdoor repeal of Obamacare. Yes, the bill would damage the quality of health insurance. And, yes, several Republican senators — starting with Susan Collins — would be violating their own stated principles if they vote for the tax bill. But damage to Obamacare isn’t the same thing as a slippery slope toward the program’s demise. The two core pieces of Obamacare are the subsidies that help middle-class families afford private insurance and the expansion of Medicaid for working-class families. The tax bill doesn’t get rid of either. Instead, it will likely repeal the individual mandate — the requirement that people buy health insurance. As a result, health-insurance markets will suffer some turmoil, and costs for some families will rise. (David Leonhardt, 12/6)

RealClear Health: Tax Reform’s Unhealthy Omission
The House and Senate recently passed tax reform bills because they successfully made the case that reform is a “once-in-a-generation” opportunity that is long overdue. It’s a compelling argument. When the last tax reform bill passed in 1986 the Internet was in its infancy and cell phones were the size of a briefcase. The world has changed, the argument goes, but our tax code has not. What’s curious, however, is that the largest deduction in the tax code – the exclusion from income tax of employer-sponsored insurance, which dates back to the 1940s – is untouched by the reform bills. This omission is an enormous missed opportunity for American consumers and both political parties. (Scott Flanders, 12/7)

Cleveland Plain Dealer: FDA Needs To Deal With Shortages Of Critically Needed Drugs
The world's attention has been rightly focused on the havoc wrought by Hurricane Maria on Puerto Rico and the suffering of the people of the island. But it's also worth paying attention to the storm's impact on the drug manufacturing plants that constitute a major component of Puerto Rico's economy. (Philip M. Rosoff, 12/6)

JAMA Forum: A Path To Health Care For All?
Health care coverage for every single person in the United States is coming. You may not be able to see it from the brutal politics of the moment. But if we step back from the health care battles in Congress and look instead at the social and economic forces brewing, as well as the new frontier of medical science, there is a path that eventually will prevail in ensuring that everyone has access to the affordable care they need. (Andy Slavitt, 12/5)

Topeka Capital Journal: Medicaid Backlog Hurts Our Seniors
For more than two years, Kansas has been struggling to eliminate its backlog of Medicaid applications. After the state activated the Kansas Eligibility Enforcement System (which was designed to make application processing more efficient) in June 2015, the backlog exploded. ... This has had a particularly harmful impact on our seniors, who are disproportionately likely to rely on Medicaid. When patients in need of hospice care are discharged from hospitals, many nursing homes refuse to admit them because they’re still waiting for Medicaid coverage. (12/6)

The Washington Post: Our Medicare Policy For Kidney Transplants Is Totally Irrational
Since 1972, Medicare has provided coverage to patients with kidney failure, regardless of age or disability status. However, while there is no time limit for dialysis patients, kidney transplant recipients who are not otherwise eligible for Medicare lose their coverage 36 months after they receive their transplant — leaving many unable to pay for immunosuppressive medications. Without access to these medications, patients eventually lose their transplants and require dialysis treatment instead. This policy is irrational, since Medicare has already paid for the kidney transplant and will pay to treat the patient with dialysis — despite its markedly higher cost — when the transplanted kidney fails. (Marcello Tonelli and John Gill, 12/6)

JAMA: Moral Choices For Today’s Physician
The work of a physician as healer cannot stop at the door of an office, the threshold of an operating room, or the front gate of a hospital. The rescue of a society and the restoration of a political ethos that remembers to heal have become the physician’s jobs, too. Professional silence in the face of social injustice is wrong. It is chilling to see the great institutions of health care, hospitals, physician groups, scientific bodies assume that the seat of bystander is available. That seat is gone. To try to avoid the political fray through silence is impossible, because silence is now political. Either engage, or assist the harm. There is no third choice. (Donald M. Berwick, 12/5)